Biologic Agents Are Associated with Excessive Weight Gain in Children with Inflammatory Bowel Disease

Haas L1, Chevalier R2, Major BT3, Enders F3, Kumar S4, Tung J5. Dig Dis Sci. 2017 Sep 11. doi: 10.1007/s10620-017-4745-1. [Epub ahead of print]
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1 Mayo Medical School, Rochester, MN, USA. 2 Department of Pediatrics, Childrens Mercy Hospital, Kansas City, MO, USA. 3 Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA. 4 Division of Pediatric Endocrinology, Mayo Clinic, Rochester, MN, USA. 5 Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. tung.jeanne@mayo.edu.


BACKGROUND: Children with active inflammatory bowel disease (IBD) are frequently underweight. Anti-tumor necrosis factor (anti-TNF) agents may induce remission and restore growth. However, its use in other autoimmune diseases has been associated with excess weight gain. Our aim was to examine whether children with IBD could experience excess weight gain.

METHODS: A centralized diagnostic index identified pediatric IBD patients evaluated at our institution who received anti-TNF therapy for at least 1 year between August 1998 and December 2013. Anthropometric data were collected at time of anti-TNF initiation and annually. Excess weight gain was defined as ΔBMI SDS (standard deviation score) where patients were (1) reclassified from "normal" to "overweight/obese," (2) "overweight" to "obese," or (2) a final BMI SDS >0 and ΔSDS >0.5.

RESULTS: During the study period, 268 children received anti-TNF therapy. Of these, 69 had sufficient follow-up for a median of 29.3 months. Median age at first anti-TNF dose was 12.8 years. At baseline, mean weight SDS was -0.7 (SD 1.4), while mean BMI SDS was -0.6 (1.3). Using baseline BMI SDS, 11.6% were overweight/obese. At last follow-up (LFU), however, the mean ΔBMI SDS was 0.50 (p < 0.0001). However, 10 (17%) patients had excess weight gain at LFU; 3 patients were reclassified from "normal" to "obese," and 7 had a final BMI SDS >0 and ΔSDS >0.5.

CONCLUSIONS: Pediatric patients with IBD may experience excess weight gain when treated with anti-TNF agents. Monitoring for this side effect is warranted.

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